Even health care, the strongest sector of the U.S. jobs market, cannot deliver the wages its workers deserve without unionization

The growth of jobs in the U.S. health care industry is the linchpin to a strong U.S. labor market in 2025 and beyond. Health care is one of only a handful of sectors to register sustained month-on-month growth in August, the most recent month for which complete data are available, and accounts for about one-third of all employment growth over the past year. But how health care workers are faring in terms of wage gains and job quality is another story.

Not too long ago, amid the height of the COVID-19 pandemic in 2020 and 2021, nurses and other health care workers enjoyed a surge in social standing and pay. They were declared essential workers and national heroes. And their economic standing improved as the pandemic labor shortage and their desperately needed skills drove up their wages across the country. 

What did not happen, however, was an increase in health care workers joining unions, which could have translated these positive developments into lasting economic gains. When the pandemic began to abate with the rise in COVID-19 immunization rates, so too did the labor shortages and the public appreciation that had driven up health care workers’ economic and social standing. Hospitals and nursing homes quickly reduced wages and benefits—and nonunionized workers were helpless to stop them.

This is a feature, of course, not a bug, of the U.S. labor market overall. Poor job quality—where workers earn low wages, work unstable hours, and receive declining benefits—means that in addition to reduced earnings, workers also derive less social standing from their jobs. And without the clout of being a member of a labor union, they cannot negotiate real wage gains as inflation once again picks up steam.

But job quality does not have to continue its decline in the United States. The decline of union power in our nation can be reversed—and health care workers can lead the way.

Because the health care workforce is expected to grow faster than any other part of the U.S. economy in the coming decades, reversing these workers’ economic precariousness not only can improve the quality of health care jobs but also can demonstrate the importance of unions in making that happen. And the economic benefits of unionization in the health care industry are clear. As with the benefits of unions more broadly, unionized health care workers have higher weekly earnings and are more likely to have retirement benefits and employer-sponsored, full-premium-covered health insurance.

Earlier this year, thousands of health care professionals across eight hospitals and six clinics in Oregon struck for 46 days, yielding contract raises of up to 22 percent, improved staffing plans, paid missed breaks, and retroactive compensation. Our research shows that unionization also improves workplace safety for health care workers by compelling employers to comply with basic labor laws.

The benefits of unionization were especially stark during the COVID-19 pandemic. In another study, we found that during the first year and a half of the pandemic, unionized nursing homes throughout the continental United States had 7 percent lower COVID-19 infection rates among workers. This union “safety premium” was especially large for Black workers, who are often exposed to the most dangerous workplace hazards, in nursing homes and writ large in U.S. workplaces. In nursing homes with higher percentages of Black workers, unions were associated with 14 percent lower COVID-19 infection rates for workers.

We also found that the lower infection rates for workers meant lower mortality rates for nursing home residents. In unionized nursing homes, the COVID-19 mortality rate for residents was 11 percent lower than in nonunion nursing homes. As many health care workers succinctly explained to a local reporter in California at the height of the pandemic, “If we get sick, you get sick.” Our research suggests that industrywide unionization would have avoided 8,000 nursing home resident deaths in the United States from June 2020 through March 2021.

In short, increased unionization in health care could help to transform hazardous, low-wage jobs into safer jobs, and those workplace improvements would also boost the quality of care for millions of patients. Beyond workplace safety, unionization would increase wages for a vast and rapidly growing workforce of roughly 22 million workers. A recent study finds that unionized health care workers earn an additional $123 per week. With only 7 percent of U.S. health care workers unionized, industrywide unionization could transfer $130 billion a year to health care workers and significantly decrease the country’s runaway income inequality.

The future of the U.S. labor movement depends crucially on improving job quality, increasing the social status of average workers, and rebuilding unions’ standing as a necessary force for all workers nationwide. Health care workers are well-positioned to lead that struggle—in the breakroom, at the bargaining table, and on the picket line.

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